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Please bring this form with
you to:
3948 Forest Oaks Dr.
Mebane, NC 27302
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Class_______ Time__________
Day_________ other__________ |
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Class_______ Time__________
Day_________ other__________ |
Name: _________________________ Age: _____
Parent/Guardian Name:_________________________
Address: ___________________________ City:
_____________________ State: _______ Zip: ________
Home Phone: _________________________ Cell/Work
Phone: _____________________
Email: ________________________________
Emergency Contact: ______________________________
Phone: _______________________________
I have enclosed a $25 registration fee along with the
first month's fees in the amount of $____________.
Payment: Cash or checks payable to The Turning Pointe
are accepted. Monthly fees due by the 5th of each
month.
Participation in any The Turning Pointe activities
involve risk of accidental injury despite all safety
precautions. Having been informed of the activities
to be conducted by The Turning Pointe, I/We, as an
individual or as a parent or guardian of the
participants name herein, assume all risks and hazards
incidental to the activities, and release from
responsibility and all liability, claims, costs,
damages including attorneys fees and costs, and agree
to indemnify and hold harmless to the Turning Pointe,
its directors, instructors, independent contractors,
volunteers, and all employees from any illness,
injury, or damage to me or my children or family
members occurring during my/his/her/our participation
in any activities conducted by The Turning Pointe.
Signature _________________________________________
Date_____________ |
Dancer Release
I, _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
, hereby irrevocably authorize The Turning Pointe Dance
Studio to use photographs of me and or my property and
authorize him/(her/their and his/her/their assignees,
licensees, legal representatives and transferees to use and
publish (with or without my name, company name, or with a
fictitious name) photographs, pictures, portraits or images
herein described in any and all forms and media and in all
manners including composite images or distorted
representations, and the purposes of publicity,
illustration, commercial art, advertising, publishing
(including publishing in electronic form on CDs or Internet
websites), for any product or services, or other lawful uses
as may be determined by the Turning Pointe.
I permit the Studio referred to above, and his licenses or
assignees, to use the photographs referred to and/or
drawings there from and any other reproductions thereof,
either complete or in part, alone or in conjunction with and
wording and/or drawings, solely and exclusively for:-
Editorial - Experimental - PR - Press Advertising - Display
Material - Packaging - Web Advertising Territorial
Limits: Worldwide
Specific Exclusions: None
- I understand that such copyright material shall be deemed
to represent an imaginary person.
- I understand that I do not own copyright of the
photograph(s) referred to on this document.
I further waive
any and all rights to review or approve any uses of the
images, any written copy or finished product. I have read
and fully understand the terms of this release.
Name of
Dancer:_______________________________________
Address:______________________________________________________________
Signature of
Dancer:_____________________________________________________
Signature of
Parent (if Dancer is under 18 yrs
old):______________________________ Date:________
Witness:________________________________________________
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